Prostate cancer screening guidelines evolve

Early detection can be a lifesaver

Jun. 5, 2013

Dr. Chirasakdi Ratanawong of Marshfield Clinic Weston Center.

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According to the most recent data, when including all men with prostate cancer: The relative 5-year survival rate is nearly 100% The relative 10-year survival rate is 98% The 15-year relative survival rate is 93% Many other factors may affect a man's outlook, such as the Gleason score, the PSA, and the man's overall health. Source: American Cancer Society

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Current tests for prostate cancer have proven useful, but there’s a major downside. The blood test does not reveal what type of cancer a man has, the kind that will spread to other parts of the body and cause harm or the slow-growing form that might never interfere with body functions.

Simply by living longer, men will have more risk for prostate cancer. According to the American Cancer Society, about 17 out of 100 of men (17 percent) who are now age 50 will be diagnosed with prostate cancer during their life.

Pat Wallschlaeger of Wausau was 56 years old when his screening for prostate cancer showed an elevated PSA (prostate-specific antigen) blood test and his doctor referred him to a urologist, Dr. Chirasakdi Ratanawong of Marshfield Clinic Weston Center.

And although his biopsy did not locate a tumor, Wallschlaeger stayed under the yearly care of his urologist after the initial false positive.

He never had symptoms and did not have another elevated PSA test, but a rectal exam, which can detect the prostate size, shape and texture, alarmed Dr. Ratanawong and another biopsy was ordered for Wallschlaeger – this time it was cancer.

At age 62, Wallschlaeger had surgery to remove the tumor in January and tests revealed it was contained to just 20 percent of the prostate.

The early intervention had given him an excellent prognosis.

“Most have many options available in early detection,” Dr. Ratanawong said. It’s a common, but not deadly, disease when caught before the cancer spreads to lymph nodes outside the prostate.

There has been a drop in prostate cancer death rates from PSA screenings, diagnosing men with elevated levels of the protein produced by cells of the prostate gland. Yet, it is complicated because men with cancer might not show an elevated PSA and treatment might not be needed for those who do have elevated PSA results.

New American Urological Association screening guidelines released this year do not suggest routine PSA screening for men under 55, at average risk. However in men 55 to 69, the benefit of screening does outweigh the risk of overtreatment, such as biopsy, said Dr. Ratanawong. Those at higher risk, such as African American men and those a family history of prostate cancer, should consult with their doctor about how often to screen. Some men over age 70 who are in excellent health may benefit from prostate cancer screening.

“I know men who won’t get screening,” Wallschlaeger said. But with a clean bill of health for prostate cancer – a 99.9 chance of it never reappearing – Wallschlaeger said he’s a believer. He credits his early detection to yearly physical screening with a urologist in combination with a PSA.

“Screening probably saved my life,” he said.

“We understand PSA is a good test, but not a perfect test. It doesn’t tell us about the risk of the most aggressive prostate cancer,” Ratanawong said. The future goal, he said, is to identify genetic markers and have a blood test that tells health providers the types of cancer the patients has, serious or low grade malignancies. About 10 to 15 percent will get aggressive cancer, but Ratanawong said 85 percent of patients will have low-aggressive, slow growing cancer.